Helpless patients used as pawns
• Disabled people paraded in public in battle over state subsidies
With the memory of the tragic deaths of 144 mental health patients at Life Esidimeni still etched in SA’s psyche, another instance of the disdain shown to intellectually and physically disabled people has emerged in Mpumalanga.
This time, NGO Sunfield Home Fortuna, which houses almost 70 physically and intellectually disabled people at its Balfour facility, deemed it fit to parade some of the patients at the offices of the provincial department of social development (DSD) in its run-ins with the department over subsidies.
About 36 of the patients in Sunfield’s care are statesubsidised by the department in the province. The monthly subsidy of R1,984 per patient has not been increased since 2008, causing serious tensions between the NGO and the department.
To express its displeasure at the inadequate funding or delays in payments, Sunfield has presented patients to the department’s offices — conduct that Mpumalanga high court acting judge N Mazibuko has condemned.
“I found Sunfield’s conduct to be a serious violation of the patients’ rights to dignity. The patients with their different disabilities, physical and intellectual, were taken to an office where the officials and other people (the public) could not have been aware of the patients’ sickness or condition. The public’s reaction to seeing the patients from Sunfield ... is safer left to the imagination,” Mazibuko said. “Conversely, some patients might be unaware of their surroundings.
“It is disappointing that the patients were exposed to such treatment by Sunfield, the facility acting instead of the DSD or delegated by the DSD to care for these patients.
“A human being cannot be used as a tool to put pressure or for negotiation. It does not matter under what circumstances they find themselves, be it sickness, a condition, or a lack of basic needs,” the judge said.
The scandal in Mpumalanga is the latest case of poor governance and human rights violations that threatens to further erode the public’s trust in the government’s ability to deliver services, especially for vulnerable and marginalised groups.
Mazibuko called out the department of social development and the department of health for not clamping down on such conduct.
“Noting Sunfield’s conduct, DSD ought to have realised then that the patients’ welfare at Sunfield was no longer secured and protected, necessitating prompt removal and placement of the patients in the facility where they would be treated with respect and dignity,” reads the judgment.
“DSD and [department of health] are responsible for avoiding a situation or state of
affairs that endangers life or health or that adversely affects the wellbeing of the patients.”
The judge ordered the two departments to rescreen all state-subsidised residents in other facilities “with the same or similar” circumstances as those in Sunfield, across Mpumalanga by May 4.
Mazibuko said this is to ensure proper classification, allocation and accommodation to an appropriate facility in terms of Mental Health Care Act guidelines. After the classification, the department must accommodate the patients in an appropriate facility by July.
In the Life Isidemeni scandal the removal of nearly 2,000 mental health patients from hospital settings in Gauteng and into unlicensed NGOs led to the deaths of 144. A report released by Prof Malegapuru Makgoba in 2017 found that many of the deaths were caused by reasons other than “mental health”. He also found all 27 NGOs to which people were transferred from Life Esidimeni were operating with invalid licences.
Retired deputy chief justice Dikgang Moseneke later castigated high-ranking government officials for the “wanton, arbitrary and unaccounted decision” to discharge patients from Life Esidimeni into the care of unlicensed NGOs.
Proceedings in the Life Esidimeni inquest wrapped up in the high court in Pretoria in November. Civil society organisation Section 27 has called for criminal charges against the former head of the Gauteng mental health services, Makgabo Manamela, and former Gauteng health MEC Qedani Mahlangu.
The organisation has also called for Ethel Ncube, the owner of Precious Angels, the NGO where 20 mental health patients died, to be charged with culpable homicide.
It appears the government has not heeded the lessons it ought to have learnt from this avoidable tragedy.
Sunfield, too, is an unlicensed NGO in terms of the Mental Health Care Act, and, according to the SA Human Rights Commission (SAHRC), the NGO is not competent to accommodate people with mental and intellectual disabilities.
“Of great concern to the commission is the submission by the department of social development that the second applicant [Sunfield] is not licensed to accommodate people with mental and intellectual disabilities, yet it is at present accommodating such patients,” SAHRC said in its report, which Business Day has seen.
“This points to a lack of oversight, nullity of monitoring or inspection ... to ensure compliance with the norms and standards required ... It may also be indicative of the lack of auditing by the department, as required by the guidelines.”
The commission raised concerns about Sunfield not keeping comprehensive files on patients. “This raises a question … on whether the second applicant has the necessary capacity, skills and competence to take care of the residents.”
Sunfield did not respond to requests for comment and neither did the department of social development in Mpumalanga.
Sunfield, with the help of AfriForum, managed to get a court order compelling the government to increase the R1,984 per patient per month subsidy, which has not been raised in 16 years.
The NGO told the court that its monthly operating expense per patient is R7,637. Apart from the subsidy of R1,984, each patient receives a monthly social grant of R1,990, which is paid directly to Sunfield. It said this leaves it with a shortfall of about R3,663.23 per patient.
The relationship between the department and the NGO is governed by a service level agreement, which has not been in place since December 2022 after a dispute.
The department told the court that the decision not to increase the subsidy was due to the budget allocated by the Treasury. It said it has continued to show the Treasury its shortfalls and budget pressures to secure additional funding.
Mazibuko ordered that the state-subsidised patients remain at Sunfield until a proper classification has been concluded and the funding issue has been appropriately addressed.
The judge said the department must continue to make payments of R1,984 per month per state-subsidised resident to Sunfield until a new service level agreement has been reached, and that such subsidies must be increased with effect from April.
“In the event that the [department] and Sunfield do not agree regarding the subsidy amount or increase thereof or any matter, the [department] has to remove and house the patients in an appropriate facility within six weeks of such a disagreement,” Mazibuko ordered.
“[The department of social development] will, with effect from April 1 2024, make payment to facilities of the same or similar circumstances to that of Sunfield in the Mpumalanga province towards the statesubsidised residents’ subsidy in the amount of R7,637.23, or an agreed amount per month per state-subsidised resident.
“An annual increase in the subsidy shall be budgeted for by considering the consumer price index or agreed percentage.”
Louis Boshoff, campaign officer at AfriForum, said: “It is shocking to witness the ANCcontrolled authorities’ indifference to the wellbeing of the most vulnerable people in society.
“AfriForum will continue to monitor the situation to ensure that the state’s negligence is rectified. AfriForum will also remain vigilant to hold authorities accountable for fulfilling their responsibilities towards the most vulnerable members of society.”